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Ginger Root August 21, 2020

Primary Care Networks – a year in review by Jonathan Harte, Clinical Director, BACHS Primary Care Network

Following the publication of the Long-Term Plan NHS England provided a framework for Primary Care Networks (PCNs), local networks of GP practices and other primary care services (such as community, mental health, social care, pharmacy, hospital and voluntary services), who work together for their local population and are defined by local geography or neighbourhood.

In Nottingham city we have eight PCN’s that were formed in July 2019. Our PCN practices work together under the leadership of a Clinical Director (like me) to improve patient access to services, and the wider health and care system. So, as we celebrate the end of our first year, I wanted to take a moment to reflect on the transformation that is underway.

Additional capacity
Healthcare is renowned for struggling to keep up with demand for appointments. And, in Nottingham city we are no different. However, by listening to the feedback of our patients, and working together locally, we are making changes that enable more proactive, personalised, and coordinated care.

Our Clinical Directors and Deputy Clinical Directors are working in each PCN to create locally focused strategic plans. Resulting in local services that reflect the needs of their local populations’ specific health and care needs. Notably this year we have employed 13 Social Prescribing Link Workers, 22 Clinical Pharmacists and 7 First Contact Practitioners who have enabled patients to be seen more appropriately for their needs releasing GP appointment time to manage other complex cases.

We are also consistently delivering an additional 195 hours (approximately) of GP appointment time per week through ‘Extended Hours’ out in PCN neighbourhoods and the Extended Access GP+ service at Upper Parliament Street.

Quality Improvement
This year we have begun a number of improvement works including, but not limited to:
Prescribing safely and safe use of medicines with shared learning to reduce harm though PCNs and Clinical Pharmacists
Safer use of NSAIDs – reduce complications (GI bleed)
Lithium Prescribing – better monitoring systems
Valproate and pregnancy prevention – engaging patients

Improving involvement of carers in end of life care and ensuring a coordinated care response to work better with palliative teams and carers and care homes
Better identification of people in the last year of life
Involvement, support and care for those important to the dying person
Coordinated care, responsive to patient’s changing needs
Still in their infancy our PCNs are evolving and developing. Therefore, having a global pandemic occur six months into their first year of formation has been both a blessing and a curse.

Our collective PCN response to Covid has been excellent. There has been considerable work undertaken by PCNs, the GP Alliance and the CCG’s locality team to set up Clinical Management Centres (CMCs) for the city. Allowing those patients with Covid symptoms to be safely seen by a doctor, while minimising risk to the health of the general population. The two CMCs, at Bulwell and St Anns, were staffed with support from the PCN teams, practice staff and the city locality team. We now have one CMC in operation at Nottingham City GP Alliance, Angel Row Entrance, that will take us through the coming winter period.

During the peak of the pandemic Nottingham City GP Alliance also ran a home visiting service for people too unwell to travel. This was a real success enabling people with suspected Covid symptoms to be seen in the community, reducing demand on other services.

The Social Prescribing Link Workers workforce recruited by PCNs have been supporting patients who were shielding with vital contact and support. Involving other agencies, as and when required, to safeguard our local population.

The team of Clinical Pharmacists are supporting practices with medication management processes such as electronic repeat dispensing, and remote medication reviews.

There is no escaping that Covid has likely changed general practice and our ways of working forever. And it has shown what is possible when organisations across all sectors pull together around a shared goal.

Restoration and recovery
As restoration and recovery of primary care occurs  PCNs will look to embed collaborative working into their plans, making connections across all health and care partners and bringing on board more community colleagues.

Some PCNs are looking at creating a Deep End Project group to support and improve care in the most deprived parts of the city.

The next 12 months will also see a focus on service specifications for enhanced support to Care Homes, improving early cancer diagnosis and improving support to those with Learning Disabilities linking to the Nottingham City ICP Priorities.